Department of Hematology, Peking University Third Hospital, Beijing 100191, China.
Mediators Inflamm. 2023 Apr 15;2023:7874239. doi: 10.1155/2023/7874239. eCollection 2023.
Diffuse large B-cell lymphoma (DLBCL) is an aggressive malignancy, and about 60% of the patients are diagnosed in their elderly age (≥65 years old). However, little is known about the early mortality and risk factors related to elderly patients with DLBCL. . From 2000 to 2019, elderly patients diagnosed with DLBCL in the Surveillance, Epidemiology, and End Result (SEER) database were involved in this research and served as test cohort. Moreover, elderly DLBCL patients from Peking University Third Hospital were used for external validation cohort. Risk factors were identified by univariate and multivariate logistic regression analyses. Nomogram models were constructed based on significance risk factors to predict the overall and cancer-specific early death. Besides that, the predictive value of the models was validated by receiver operating characteristic (ROC) analysis. Calibration plots were used to evaluate the calibrating ability. Clinical benefits of nomogram were evaluated by decision curve analysis (DCA).
15242 elderly DLBCL patients obtained from the SEER database and 152 patients from Peking University Third Hospital were enrolled in this research. In the SEER database, 36.6% (5584/15242) of the patients had early death and 30.7% (4680/15242) of them were cancer-specific early death. Marital status, Ann Arbor stage, surgical treatment, radiotherapy, and chemotherapy were significant risk factors for overall and cancer-specific early death of elderly DLBCL patients. Nomograms were constructed according to these risk factors. Then, ROC analysis showed that the AUC of OS was 0.764 (0.7560.772), and CSS was 0.742 (0.7330.751). In the validation group, the AUC of OS was 0.767 (0.6890.846) and CSS was 0.742 (0.7430.83).
The calibration plots and DCA analysis revealed that the nomograms were good at early death prediction and clinical application. Predictive dynamic nomogram models for elderly DLBCL patients were established and validated, which might play an essential role in helping physicians enact better treatment strategies.
弥漫性大 B 细胞淋巴瘤（DLBCL）是一种侵袭性恶性肿瘤，约 60%的患者在老年（≥65 岁）时被诊断出来。然而，对于老年 DLBCL 患者的早期死亡率和相关风险因素知之甚少。本研究纳入了 2000 年至 2019 年在监测、流行病学和最终结果（SEER）数据库中诊断为 DLBCL 的老年患者，并作为测试队列。此外，北京大学第三医院的老年 DLBCL 患者用于外部验证队列。通过单因素和多因素逻辑回归分析确定了危险因素。基于显著的危险因素构建列线图模型，以预测总生存期和癌症特异性早期死亡。此外，通过接收者操作特征（ROC）分析验证模型的预测价值。校准图用于评估校准能力。通过决策曲线分析（DCA）评估列线图的临床获益。
从 SEER 数据库中获得了 15242 例老年 DLBCL 患者和北京大学第三医院的 152 例患者，纳入本研究。在 SEER 数据库中，36.6%（5584/15242）的患者发生早期死亡，30.7%（4680/15242）的患者发生癌症特异性早期死亡。婚姻状况、Ann Arbor 分期、手术治疗、放疗和化疗是老年 DLBCL 患者总生存期和癌症特异性早期死亡的显著危险因素。根据这些危险因素构建了列线图。然后，ROC 分析显示 OS 的 AUC 为 0.764（0.7560.772），CSS 的 AUC 为 0.742（0.7330.751）。在验证组中，OS 的 AUC 为 0.767（0.6890.846），CSS 的 AUC 为 0.742（0.7430.83）。
校准图和 DCA 分析表明，该列线图在早期死亡预测和临床应用方面表现良好。建立并验证了老年 DLBCL 患者的预测动态列线图模型，这可能有助于医生制定更好的治疗策略。
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